Legislation & Regulation
Richard Mark Kirkner
Because hospital spending makes up the largest piece of U.S. health care spending—32%, according to data from CMS—any judicial rulings or legislative move to curb a hospital’s market dominance are key to controlling overall health care costs. The FTC is stepping in.

The American Medical Association (AMA) is being inundated by tweets from doctors furious that the organization supports the nomination of Republican House Budget Committee Chairman Tom Price for secretary of the Health and Human Services Department, according to STAT.

Viewpoint
Zachary Hafner

Zachary Hafner
Advisory Board

The transformation of health care is fundamentally altering the environment in which health systems function, placing the CMO squarely at the center of a new reality where concepts like value, population health management, and outcomes-based payment are becoming key drivers of success.

By a 392 to 26 vote, the House of Representatives passed the 21st Century Cures Act, which would speed FDA approval for drugs and medical devices and allow the agency to include real world evidence in the approval process.

ACO Update
Michael D. Dalzell

Gregory Paulson
Trenton Health Team

Applying the ACO framework to Medicaid runs head on into a stubborn challenge: the disproportionate impact of socioeconomic factors on health in the Medicaid population. Poor health outcomes in low-income populations are often exacerbated by unstable employment and housing, transportation difficulties, and lack of access to nutritious food.

Morgan Kendrick, Anthem’s president of national accounts, testified that the plan’s $48 billion proposed merger with Cigna will not undermine competition, as the Justice Department argues in the antitrust suit it brought against the merger.

The decades of good childhood vaccinations have done might not continue apace under the coming Trump administration. The anti-vaccine movement believes that vaccines can cause health problems in children, most notably autism.

Medical Director Profiles
Howard Wolinsky

Neal Kaufman, MD

“My job as CMO is to make sure we’re keeping the patient at the center—that our products make sense to them and to clinicians,” he says. Canary’s programs come from protocols that have been vetted by scientists, clinicians, and patients over many years, if not decades.

Forget, “Can this marriage be saved?” Can this engagement be saved? Dating? How about distant friendship? Newly opened court testimony reveals that the differences between Anthem and Cigna might make for an unhappy coupling, should their merger be approved.

Seema Verma, a longtime advisor to Vice president Elect Mike Pence, has been nominated by President-elect Donald trump to head the Centers for Medicare and Medicaid Services. CMS oversees Medicare, Medicaid and some aspects of the ACA, affecting the lives of some 100 million Americans.

Republican House Budget Committee Chairman Tom Price, who President-elect Donald Trump nominated for secretary of the Health and Human Services Department, is 62-year-old former orthopedic surgeon who has championed a Republican vision of health care reform at odds with the ACA.

Medical Director Profiles
Howard Wolinsky

Steve Miller, MD

“Some days I’m out supporting our sales people and trying to acquire new business. Some days I’m with our legal teams trying to help them decipher new regulations. Some days I am with our supply team group negotiating with the pharmaceutical companies.”

State Medicaid programs are more willing to take on care of those with disabilities in managed long-term supports and services (MLTSS) programs, and they’re using managed Medicaid plans to do so, according to Modern Healthcare.

“Now why did I just enter this room?” Sound familiar? It’s the question many people ask when they decide to, for instance, grab a notepad and pen and then forget that was their mission.

Medical Director Profiles
Howard Wolinsky

Sylvia Meltzer, MD

She was responsible for incorporating the population health perspective in the newly launched Well Priority insurance product created by Aurora and Anthem Blue Cross and Blue Shield in Wisconsin. The companies teamed up to create Wisconsin Collaborative Insurance Company, a joint venture health insurance company.
Medical Director Profiles
Timothy Kelley

Eneida O. Roldan, MD

Her long-term plans for the system met with stiff opposition and politics got in the way, she says. When she resigned in 2010, one news account quoted an anonymous source as saying she was tired of being a punching bag.
Medical Director Profiles
Timothy Kelley

Warachal Eileen Faison, MD

As part of a team that oversees the development of clinical trials, she helps to determine “what endpoints are clinically meaningful.” She supervises the development of safety and effectiveness data, and reviews the performance of drugs even after they’ve been approved.